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. 2022 Sep 1;7(9):900-904.
doi: 10.1001/jamacardio.2022.2213.

Demographic and Regional Trends of Heart Failure-Related Mortality in Young Adults in the US, 1999-2019

Vardhman Jain  1 , Abdul Mannan Khan Minhas  2 , Alanna A Morris  3 , Stephen J Greene  4   5 , Ambarish Pandey  6 , Sadiya S Khan  7   8 , Gregg C Fonarow  9   10 , Robert J Mentz  4   5 , Javed Butler  11   12 , Muhammad Shahzeb Khan  4
Affiliations

Demographic and Regional Trends of Heart Failure-Related Mortality in Young Adults in the US, 1999-2019

Vardhman Jain et al. JAMA Cardiol. .

Abstract

Importance: There are limited data on mortality trends in young adults with heart failure (HF).

Objective: To study the trends in HF-related mortality among young adults.

Design, setting, and participants: This retrospective cohort analysis used mortality data of young adults aged 15 to 44 years with HF listed as a contributing or underlying cause of death in the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from January 1999 to December 2019. Analysis took place in October 2021.

Exposures: Age 15 to 44 years with HF listed as a contributing or underlying cause of death.

Main outcomes and measures: HF-related age-adjusted mortality rates (AAMR) per 100 000 US population stratified by sex, race and ethnicity, and geographic areas.

Results: Between 1999 and 2019, a total of 61 729 HF-related deaths occurred in young adults. Of these, 38 629 (62.0%) were men and 23 460 (38.0%) were women, and 22 156 (35.9%) were Black, 6648 (10.8%) were Hispanic, and 30 145 (48.8%) were White. The overall AAMR per 100 000 persons for HF in young adults increased from 2.36 in 1999 to 3.16 in 2019. HF mortality increased in young men and women, with men having higher AAMRs throughout the study period. AAMR increased for all race and ethnicity groups, with Black adults having the highest AAMRs (6.41 in 1999 and 8.58 in 2019). AAMR for Hispanic adults and White adults increased from 1.62 to 2.04 and 1.83 to 2.45 over the same time period, respectively. Across most demographic and regional subgroups, HF-related mortality stayed stable or decreased between 1999 and 2012, followed by an increase between 2012 and 2019. There were significant regional differences in the burden of HF-related mortality, with states in the upper 90th percentile of HF-related mortality (Oklahoma, South Carolina, Louisiana, Arkansas, Alabama, and Mississippi) having a significantly higher mortality burden compared with those in the bottom tenth percentile.

Conclusions and relevance: Following an initial period of stability, HF-related mortality in young adults increased from 2012 to 2019 in the United States. Black adults have a 3-fold higher AAMR compared with White adults, with significant geographic variation. Targeted health policy measures are needed to address the rising burden of HF in young adults, with a focus on prevention, early diagnosis, and reduction in disparities.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Morris reported grants from National Heart, Lung, and Blood Institute; Agency for Healthcare Research and Quality; Woodruff Foundation; and Association of Black Cardiologists outside the submitted work. Dr Greene reported nonfinancial support from Amgen, AstraZeneca, Bristol Myers Squibb, Cytokinentics, Merck, Novartis, and Pfizer; personal fees from Boehringer Ingelheim, Cytokinetics, AstraZeneca, Merck, Bayer, Roche Diagnostics, Vifor, Sanofi, Urovant Pharmaceuticals, Bristol Myers Squibb; research support from the American Heart Association; grants from Novartis; has served on advisory boards for Amgen, AstraZeneca, Bristol Myers Squibb, and Cytokinetics; and has served as a consultant for Amgen, Bayer, Bristol Myers Squibb, Merck and Vifor outside the submitted work. Dr Pandey reported grants from National Institute on Aging during the conduct of the study; has served on the advisory board for Roche Diagnostics and Eli Lilly; has served as a consultant for Tricog Health; nonfinancial support from Pfizer and Merck; grants from Applied Theraputics and Myovista outside the submitted work; and is supported by the Texas Health Resources Clinical Scholarship, the Gilead Sciences Research Scholar Program, the National Institute of Aging GEMSSTAR grant, and Applied Therapeutics. Dr S. Khan reported grants from American Heart Association and the National Institutes of Health outside the submitted work. Dr Fonarow reported research funding from the National Institutes of Health and personal fees from Abbott, Amgen, AstraZeneca, Bayer, Cytokinetics, Edwards, Janssen, Medtronic, Merck, and Novartis outside the submitted work. Dr Mentz reported personal fees from Bayer, Boehringer Ingelheim/Eli Lilly, Merck, Novartis, AstraZeneca, Vifor, Zoll, and Windtree; grants from American Regent; and research support and honoraria from Abbott, Amgen, Boston Scientific, Cytokinetics, Fast BioMedical, Gilead, Medtronic, Roche, and Sanofi during the conduct of the study. Dr Butler reported personal fees from Abbott, Adrenomed, Amgen, Array, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CVRx, G3 Pharmaceutical, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, Novo Nordisk, Relypsa, Roche, V-Wave Limited, and Vifor outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Trends in Heart Failure–Related Age-Adjusted Mortality Rates, Overall and Stratified by Sex Among Young Adults in the US, 1999-2019
APC indicates annual percent change. aP < .05.
Figure 2.
Figure 2.. Trends in Heart Failure–Related Age-Adjusted Mortality Rates, Overall and Stratified By Race and Ethnicity Among Young Adults in the US, 1999-2019
APC indicates annual percent change. aP < .05.
Figure 3.
Figure 3.. Trends in Heart Failure–Related Age-Adjusted Mortality Rates Stratified by Region and State Among Young Adults in the US
APC indicates annual percent change. aP < .05.
See this image and copyright information in PMC

Comment in

References

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